In vitro elimination of anti-infective drugs by the Seraph® 100 Microbind® affinity blood filter

Julius J Schmidt; Gabriele Eden; Malin-Theres Seffer; Manuela Winkler; Jan T Kielstein

doi:10.1093/ckj/sfaa063

In vitro elimination of anti-infective drugs by the Seraph^® 100 Microbind^® affinity blood filter

Clin Kidney J. 2020 May 21;13(3):421-424. doi: 10.1093/ckj/sfaa063. eCollection 2020 Jun.

Authors

Julius J Schmidt¹, Gabriele Eden², Malin-Theres Seffer², Manuela Winkler², Jan T Kielstein²

Affiliations

¹ Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
² Medical Clinic V, Nephrology | Rheumatology | Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany.

Abstract

Background: In August 2019, the European Union licensed the first ever haemoperfusion device aimed to reduce pathogens in the blood. The core of the adsorber consists of ultra-high molecular weight polyethylene beads with endpoint-attached heparin. These beads utilize pathogen inherent adhesion mechanisms to reduce pathogen load. So far, it is unknown whether the device has an effect on anti-infective drug concentrations. The aim of this study was to investigate the in vitro adsorption of multiple anti-infective drugs from human plasma.

Methods: In this in vitro study, 18 anti-infective drugs were administered to human donor plasma and pumped through the heparin-coated pathogen adsorber (Seraph^® 100 Microbind^®Affinity Blood Filter; ExThera Medical Corp., Martinez, CA, USA) at a plasma flow rate of 250 mL/min for 60 min. Pre- and post-adsorber plasma samples were quantified after 5, 15, 30 and 60 min.

Results: We found a reduction ratio (RR) in anti-infective plasma levels between -1% and 62%. This decrease occurred mainly in the first 5 min of the experiment (RR_0-5 -4 to 62%). Mean plasma clearance rates ranged between -11.93 mL/min (fluconazole) and 4.86 mL/min (clindamycin). The highest RRs were measured for aminoglycosides (tobramycin 62% and gentamycin 59%).

Conclusions: The elimination of anti-infective drugs by the Seraph is neglectable in all but 2 of 18 of the investigated substances. Aminoglycosides may be adsorbed by the device during their first pass.

Keywords: adsorber; antibiotics; in vitro; pharmacokinetics; sepsis.